Provider Demographics
NPI:1871607937
Name:WOODBURY, ROBERT ORLO (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ORLO
Last Name:WOODBURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-523-0616
Practice Address - Street 1:1701 4TH ST
Practice Address - Street 2:STE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3601
Practice Address - Country:US
Practice Address - Phone:707-579-2100
Practice Address - Fax:707-523-0616
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG77680208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G776800OtherBLUE SHIELD OF CALIFORNIA
CA1871607937Medicaid
CAP00469237OtherRAILROAD MEDICARE
CAP00469237OtherRAILROAD MEDICARE
CA00G776803Medicare PIN